CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Bellin Memorial Hospital

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $346
Cash Discount Price: $320
vs. Medicare Baseline: 2.74x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Bellin Memorial Hospital is $346. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $320. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 2.74x the Medicare baseline. Located in 744 S Webster Ave, Green Bay, WI.

Cash / Self-Pay

$320

Average discount available for prompt cash payment at this facility.

Insurance Median

$346

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$126.25

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $126.25 (100%)

Cash / Self-Pay: $320 (253%)

Insurance Median: $346 (274%)

Cash: $320 (253% of Medicare)

Ins. Median: $346 (274% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $126.25 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 274% of the Medicare baseline (a markup of 174%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Aetna	$127 - $148	101%
Blue Cross Blue Shield	$127 - $469	101%
Community Care	$127 - $277	101%
Humana	$127 - $277	101%
My Choice	$127 - $171	101%
Network Health	$127 - $370	101%
Common Ground	$296	234%
Chorus Community Health Plan	$317	251%
UnitedHealthcare	$318 - $1,132	252%
Aspirus Arise	$340 - $355	269%
Cigna	$348 - $352	276%
Wps Insurance	$360 - $419	285%
Hps/Paymedix	$365 - $394	289%
Trilogy	$375	297%
Healthsmart	$394	312%
Ihs(Claimsbridge)	$394	312%
Medical College Of Wi	$394	312%
Multiplan	$394	312%
Allied National	$419	332%
First Health	$419	332%
Galaxy Health	$419	332%
Three Rivers Provider Network	$444	352%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $320.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 77067.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Bellin Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 77067.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.